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The safety of private hospitals

An increasing number of patients are paying for private treatment to avoid delays in waiting for NHS therapies or surgeries. These are not necessarily people with health insurance. Often, they are people who are using their savings to pay for specific operations such as hip or knee replacements.

Private hospitals have experienced an increase of between 15% and 25% in the number of uninsured self-payers over several years. Mostly, this appears to be driven by the long waiting times to undergo non-urgent surgery in the NHS. The biggest increase in self-paid private surgical procedures is in replacement operations and procedures to limit the effects of disabling conditions.

Previously, there were financial penalties for the NHS if the waiting times exceeded certain limits. In July 2017 the maximum 18 weeks guaranteed under the referral to treatment scheme was removed. As a result, waiting times have increased particularly for non-urgent surgical procedures.

It also appears that there has been a rise in people paying for private cancer care. This may well be correlated to the NHS England cutting the number of drugs it pays under the cancer drugs fund.

Leaving aside whether it should be the case that somebody who is entitled to NHS care should feel forced to resort to use their savings to pay for private healthcare because of the delays in treatment, there are also issues about patient safety. Private hospitals tend to be smaller with less extensive resources and a smaller variation in staff expertise. Many of them do not have, for example, intensive care. These are often smaller units of up to 50 beds.

As a result, there are an increasing number of patients who have to be transferred from the private sector to the NHS if something goes wrong. This, of course, is an additional cost to the NHS. Current estimates are of 7000 patients being transferred to the NHS due to a lack of facilities to deal with problems in the private sector.

Many people are not aware of the difference between the staffing and resource levels of a private hospital and that of an NHS unit. For example, in an NHS hospital, there will be a number of medical staff on duty at any one time, including access to senior staff on site. In private hospitals, there is often only one junior doctor on site, particularly in the evenings, irrespective of how many patients are in the hospital at that time. With the best will in the world, not only will one junior doctor be unable to accommodate the needs of a large number of patients, but they will also not have the requisite skills or experience to recognise and deal with all the issues that may arise.

The decision as to whether to use savings to pay for an operation in the private sector should not just be concerned with waiting times in the NHS and the fees and experience of the private surgeon. Patients should be encouraged to consider the facilities at the hospital, the resources if an urgent situation arises, and of course the staffing at all times. A surgeon may appear for the surgery and then following a brief ward round, leave for their NHS practice. That may leave a private patient post-surgery with only a junior doctor for support if anything arises.

The clinical negligence lawyers at Anthony Gold see a large number of cases that arise out of private sector medicine and surgery. Some are straightforward negligence, but some arise because the hospital itself does not have the facilities to deal with emergency situations.

For example, I recently dealt with a bariatric surgery case in which the claimant had private surgery at a local small unit. She developed complications post-operatively as can occur. There was no senior surgeon or staff on site. It was a junior doctor who did his best to manage her condition overnight. As her condition deteriorated, it became apparent that the consultant was not available due to other work commitments. Eventually, a different consultant surgeon from a hospital on the other side of London was brought in to resolve a difficult situation. However, for an 18-hour period, the patient was in deteriorating under the care of a very junior doctor who did not have the requisite skill and experience to deal with the situation.

Before attending the hospital, my client had no idea that this would be the case. She had no idea that there would not be a consultant or a senior doctor at the hospital at all times. She had no idea that her surgeon was not going to be available after the surgery because of other commitments at other hospitals elsewhere (he had an extensive private practice). Nor did she realise that there were no Intensive Care beds available as the hospital had two already filled beds and no intensive care specialist. The same junior doctor that was dealing with her bariatric surgery was also dealing with the patients in the ICU. In most private hospitals the intensive care unit doesn’t exist.

Emergencies and urgent situations arise infrequently and complications can arise regardless of whether surgery or treatment is provided to an exemplary standard or not. Patients need to have an understanding of what is available if the worse happens. Had my client needed to be transferred to an NHS hospital, she would have been about 30 minutes from the nearest Emergency Department because the private hospital was set in a leafy village in the countryside. A half-hour trip when you are seriously unwell is a significant increase in risk.

Private hospitals have resisted over the years many attempts for greater regulation and greater transparency, but it must be the case that they should be able to provide to potential patients purchasing surgical and medical treatment (now often at their own expense) a full detailed analysis of what is available, what can be made available and what happens in an emergency situation.

It is important that patients are aware because although a complication may not be negligent, the management of it may be and that has to include the failure to have sufficient facilities and appropriate staff to deal with the unforeseen. Private healthcare companies absolutely need to provide proper information to patients and that has to include arrangements for any problems that may arise.